PAT-2. Composite gastric carcinoma arising in a background of lymphocytic gastritis.Composite carcinoma is a rare malignant neoplasm neoplasm or tumor, tissue composed of cells that grow in an abnormal way. Normal tissue is growth-limited, i.e., cell reproduction is equal to cell death. composed of two different types of tumor in discrete areas intermingled with each other, probably representing a single neoplasm with multidirectional differentiation. We present a case of gastric composite carcinoma composed of adenocarcinoma and neuroendocrine carcinoma that appeared to arise from a background of lymphocytic gastritis. The association of gastric carcinoma with lymphocytic gastritis has not to our knowledge been reported before. The patient is a 55-year-old male with 4-month history of anemia and tarry stools. An endoscopy showed a large mass on the lesser curvature of the stomach The lesser curvature of the stomach, extending between the cardiac and pyloric orifices, forms the right or posterior border of the stomach. It descends as a continuation of the right margin of the esophagus in front of the fibers of the right crus of the diaphragm, and . Biopsies demonstrated invasive poorly differentiated adenocarcinoma. A CT scan revealed no evidence of metastatic disease. The patient underwent partial gastrectomy gastrectomy Surgical removal of all or part of the stomach to treat peptic ulcers. It eliminates the cells that secrete acid and halts the production of gastrin, the hormone that stimulates them. Once a common operation, it is now a last resort. . Past medical history is significant for coronary artery disease coronary artery disease, condition that results when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue. . Social history is noticeable for tobacco use. Physical exam is unremarkable. The resected stomach grossly showed a 2.5-cm ulcerated Ulcerated Damaged so that the surface tissue is lost and/or necrotic (dead). Mentioned in: Adenoid Hyperplasia mass with heaped-up borders. Histology revealed an ulcerated carcinoma composed of discrete areas of moderately differentiated adenocarcinoma and neuroendocrine carcinoma intermingled together. The tumor infiltrated into the deep submucosa submucosa /sub·mu·co·sa/ (sub?mu-ko´sah) areolar tissue situated beneath a mucous membrane. sub·mu·co·sa n. A layer of loose connective tissue beneath a mucous membrane. of stomach. The adenocarcinoma component consisted of well-differentiated intestinal-typed glandular structures with in situ carcinoma in situ carcinoma See Carcinoma in situ. present at one edge of the lesion. The neuroendocrine carcinoma was either found adjacent to or appeared to "come off" the adenocarcinoma component. The neuroendocrine component expressed positive immunoreactivity for chromogranin, synaptophysin and bcl-2. Only the neuroendocrine carcinoma component showed extensive lymphatic and vascular invasion. The non-neoplastic stomach surrounding the tumor extensively demonstrated lymphocytic gastritis. Focal intestinal metaplasia was noted. A liver biopsy showed metastatic neuroendocrine component of the composite tumor. The endocrine component of this tumor is very aggressive with vascular invasion and liver metastases. The presence of lymphocytic gastritis suggests a possible association with gastric carcinoma. Mylinh T. Mac, MD, and Salima Haque, MD. Tulane University Health Sciences Center, Department of Pathology and Laboratory Medicine, New Orleans, LA. |
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